Provider Demographics
NPI:1053598060
Name:BONDURANT, JOSHUA J (DO)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:J
Last Name:BONDURANT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-0012
Mailing Address - Country:US
Mailing Address - Phone:773-499-8442
Mailing Address - Fax:
Practice Address - Street 1:2700 DOLBEER STREET
Practice Address - Street 2:ST JOSEPH HOSPITAL
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-269-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-049095207L00000X
CA20A 10238207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology